Healthcare Provider Details

I. General information

NPI: 1568193480
Provider Name (Legal Business Name): ADRIANA DANIELLE GARZA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16221 W 159TH ST STE 102
LOCKPORT IL
60441-7902
US

IV. Provider business mailing address

614 WOODLAWN AVE
JOLIET IL
60435-5752
US

V. Phone/Fax

Practice location:
  • Phone: 779-279-9358
  • Fax:
Mailing address:
  • Phone: 779-279-9358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149021696
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: